Trauma Care in Iraq: "Every Day We See the Worst Injuries Inflicted by This War"


Doctors Without Borders/Médecins Sans Frontières (MSF) field coordinator Jonathan Whittall has been working in MSF's newly opened field trauma hospital in a village to the south of Mosul for three weeks. The facility has received more than 1,296 patients since it opened on February 16, around half of whom were women (261 patients) and children under the age of 15 (395 patients). Here, Jonathan discusses the 24-hour emergency trauma care provided by his team of dedicated Iraqi and international staff.

What is an average day like in the hospital?

There is nothing average about a day in this hospital. Every day we see the worst of the worst injuries inflicted by this war. There is a near-constant flow of patients and every single one comes with horrific stories; an entire family has been killed, with only one survivor; a father and his son were trapped under the rubble of their house for days after an air strike and have only now reached us for help; a little boy has arrived with a gunshot wound to the head; another boy’s father tells us his son has been shot by a sniper and been treated at home for days before reaching our hospital paralyzed; a baby arrives with a bullet wound; a severely malnourished 21-year-old man with a blunt trauma to the head from a rifle butt is stretchered in; one man is dead on arrival from injuries sustained while protecting his child from nearby blasts. For each one of these cases there are hundreds of others just as horrific.

Who are the patients you are treating?

We are treating the most severe cases. We are set up to deal with what we call "red cases." These are the cases that often need immediate lifesaving or damage control surgery in order to survive. Our two operating theaters are almost always busy operating on these cases. We then refer the patients to other hospitals as quickly as we can in order to always be ready to receive other "red cases" or mass casualties.

MSF teams in and around Mosul have received more than 2,000 patients in need of urgent or lifesaving care in the last two months. The vast majority needed treatment for conflict-related trauma. In the trauma hospital south of Mosul that I am working in, we have received about 1,296 of those patients.

What kinds of injuries are being treated?

We are seeing every kind of war injury you can imagine—multiple gunshot wounds, blast injuries, severe burns. We are trying our best to deal with the medical effects of a of a high-intensity urban war unleashed on a trapped population. Everyone is at risk. Beyond the extent of their injuries, the state in which our patients arrive is also extremely disconcerting. Many have been living under siege and trapped for months, they have not eaten in days and are afraid and bewildered. They often arrive barefoot and covered in mud after having walked in the rain, across front lines in darkness, with literally nothing but the clothes on their back.

Our doctors and surgeons also treat injuries caused by the remnants of war. Just a few months ago the town where we are based was on the front line but today it is a reception point for the tens of thousands of families fleeing western Mosul. One evening we received several wounded patients after a mine was detonated close to the camp where the internally displaced people from Mosul are staying, and one morning this week we received a four-year-old child from the town that was dead on arrival after playing with an unexploded ordnance that detonated in his hands.

How do patients get to the hospital?

Patients face extreme difficulty [when it comes to] reaching health care. The ones we receive have often been stabilized at medical posts closer to the front line. We receive the "lucky" ones. From what I have seen in the hospital, it seems to me that most of the patients we receive are wounded in the middle of clashes when the front line moves through their neighborhoods.

Many are injured while trying to escape. We have seen patients with suspected sniper wounds to the back of the head; we have also seen patients that have been injured in air strikes. For patients who are injured by air strikes that happen deeper into areas controlled by IS, it seems that it can take a number of days before they are able to reach medical care in the south of Mosul. From what we understand, it is only when the front line moves through their neighborhood that they have a chance to reach medical assistance. We are extremely worried about reports that huge numbers of people trapped and wounded inside west Mosul are unable to reach medical assistance on the outside.

Over the past few days the hospital has been the calmest since we started. But we don’t think this is because the violence in west Mosul has stopped. It is a sinister calm—air strikes are continuing but patients are not reaching us.

How is this work affecting the team you are working with?

The team members working in this hospital come from many different parts of Iraq and from across the globe. We have medical staff from Mosul who can no longer work in their hospitals; international team members that have worked in multiple wars and have decades of experience in trauma surgery; and a non-medical team of guards, translators, and logisticians that keep the hospital running. For the members of the team who are from Mosul, it is especially difficult to see the level of destruction and suffering of fellow community members.

Other members of the team who are from the town in which we are based are themselves picking up the pieces of their lives after fighting moved through this town only a few months ago. Our hospital is surrounded by destroyed homes. Everyone has lost someone in this war. However, the hospital has one of the best team dynamics I have ever experienced. Everyone works around the clock and is always on call, ready to adapt and to find solutions so that we can continue to save lives. We are all extremely proud of the work that is being done here. 

"There is nothing average about a day in this hospital. Every day we see the worst of the worst injuries inflicted by this war. There is a near-constant flow of patients and every single one comes with horrific stories."

Jonathan Whittall